右美托咪定联合盐酸达克罗宁胶浆对腹腔镜胆囊切除术苏醒期躁动的影响

目的:观察术前应用右美托咪定联合达克罗宁胶浆预防腹腔镜胆囊切除术苏醒期的躁动, 评价其安全性和有效性。方法:将择期行全麻腹腔镜胆囊手术患者80例随机分为对照组(Ⅰ组)、达克罗宁组(Ⅱ组)、右美托咪定组(Ⅲ组)和右美托咪定联合达克罗宁组(Ⅳ组), 各20例, 患者均不用术前药。Ⅲ、Ⅳ组在诱导前给予右美托咪定0.6μg·kg-1·h-1负荷剂量静脉泵注, 15min后以 0.2~0.3 μg ·kg-1·h-1的剂量持续泵入,Ⅱ、Ⅳ组达克罗宁胶浆于插管前均匀涂抹气管导管头端至15 cm处, Ⅰ、Ⅱ组泵入等容量0.9%氯化钠注射液, 分别于术毕时(T₁)、气管导管拔管时(T₂)、气管导管拔除后5 min(T₃)记录平均动脉压(MAP)和心率(HR), 记录苏醒时间、拔管时间以及拔管前Riker镇静躁动评分、拔管后5min的Ramsay镇静评分。结果:Ⅰ组和Ⅱ组患者T₂、T₃时MAP均明显高于T₁, HR均明显快于T₁(P<0.01);Ⅲ组和Ⅳ组患者T₁~T₃时MAP均低于Ⅰ组(P<0.05~P<0.01), HR均明显慢于Ⅰ组(P<0.01)。4组苏醒期时间和拔管时间均无明显不同(P>0.05)。Ⅳ组患者Ramsay镇静评分均明显高于Ⅰ、Ⅱ、Ⅲ组(P<0.01);Ⅱ、Ⅲ和Ⅳ组Riker镇静躁动评分均明显低于Ⅰ组(P<0.01), Ⅲ组和Ⅳ组患者躁动发生率明显低于Ⅰ组(P<0.05)。结论:插管前输注负荷剂量右美托咪定0.6μg·kg-1·h-1, 15min后以 0.2~0.3μg ·kg-1·h-1的剂量持续泵入, 联合达克罗宁胶浆能有效降低腹腔镜胆囊切除患者苏醒期躁动, 并能降低患者拔管期心血管反应, 且不延长患者苏醒时间和拔管时间。

The effect of dexmedetomidine combined with dyclonine hydrochloride mucilage on agitation during the recovery period of laparoscopic cholecystectomy

Objective:To evaluate the safety and efficacy of dexmedetomidine combined with dyclonine hydrochloride mucilage before general anesthesia in preventing agitation during the recovery period of laparoscopic cholecystectomy. Methods:Eighty patients treated with electively laparoscopic cholecystectomy were randomly divided into the normal saline group ( group Ⅰ) , dyclonine group ( groupⅡ) ,dexmedetomidine group( groupⅢ) and dexmedetomidine combined with dyclonine group( groupⅣ) . The premedication didn't be used in all patients. Group Ⅲ and Ⅳ were treated with a loading dose of dexmedetomidine(0. 6 μg·kg-1 ·h-1 ) by intravenous infusion before anesthesia induction. After 15 min,the dose of dexmedetomidine revised by 0. 2 to 0. 3 μg·kg-1 ·h-1 . The position between the top of the tracheal tube and 15 cm was evenly covered by dyclonine hydrochloride mucilage in groupⅡ andⅣ,groupⅠand Ⅱ were injected with saline infusion. The mean arterial pressure(MAP) and heart rate(HR) in all groups were recorded after operation( T1 ) ,tracheal extubation ( T2 ) and 5 min after extubation ( T3 ) . The time of recovery and extubation, Riker sedation score before extubation and Ramsay sedation score after 5 min of extubation in four groups were observed. Results:Compared with the T1 ,the MAP and HR in groupⅠand groupⅡwere significantly higher at T2 and T3(P<0. 01). The MAP and HR in groupⅢand groupⅣwere lower than those in group Ⅰ at T1 and T3(P<0. 05 to P<0. 01). The differences of the recovery and extubation time in four groups were not statistically different(P>0. 05). The Ramsay sedation score in group Ⅳ was significantly higher than that in other three groups(P<0. 01). The Riker sedation-agitation scores in group Ⅱ,Ⅲ and Ⅳ were significantly lower than those in group Ⅰ(P<0. 01). The incidence of agitation in groupⅢandⅣwere significantly lower than that in groupⅠ(P<0. 05). Conclusions:The treatment of a loading dose of dexmedetomidine(0. 6 μg·kg-1 ·h-1 ) and 0. 2 to 0. 3 μg·kg-1 ·h-1 after 15 min before extubation combined with dyclonine hydrochloride mucilage can effectively prevent agitation of laparoscopic cholecystectomy patients during
recovery period, reduce cardiovascular reaction during extubation and not prolong the recovery and extubation time.